A 2012 study led by National Institute of Mental Health (NIMH) researcher Dr. Kathleen Merikangas found approximately 2.5 percent of minors in the United States meet the criteria for a bipolar disorder diagnosis. Bipolar disorder is believed to be caused by a combination of genetic factors and functional abnormalities in the brain, and there is a variety of treatment options available to children and teens struggling with the symptoms of manic and depressive episodes. Psychiatrists often prescribe mood stabilizers to those struggling with bipolar disorder, in tandem with psychotherapy and new research is available on the effects of antidepressants on this population.
Mood stabilizers, such as Lithium, Depakote and Tegretol, are commonly prescribed to individuals diagnosed with bipolar disorder. These are highly effective in treating the manic symptoms of bipolar disorder, including hypomania. Lithium is the only mood stabilizer recommended for children and adolescents, as research has shown the others can have detrimental long-term effects when taken before the age of 20. The drug especially helps manage rapid-cycling bipolar disorder, which is present when moods swing from depression to mania within hours or days. As Dr. Gary Sachs, the founding director of the Bipolar Clinic and Research Program at Massachusetts General Hospital, explains, “Lithium has this curious property of working both against mania and depression.” Rapid-cycling is commonly found in those with early-onset bipolar disorder. As with any prescription medication, children and teenagers are recommended to take the smallest dosage that is effective for that individual.
Antidepressants have not historically been used to treat bipolar disorder and there are none FDA-approved for that purpose. However, selective serotonin reuptake inhibitors (SSRIs) are now commonly prescribed in combination with mood stabilizers to treat depressive episodes in those with the disorder. These drugs, which were introduced in the United States in 1988 when Prozac hit the shelves, block the cellular re-absorption of serotonin, a neurotransmitter naturally produced in the brain. This increases serotonin levels in the brain, elevating the user’s mood. However, SSRIs include the FDA’s black box warning for risk of suicidal thoughts and/or actions when taken by children and teenagers.
According to a recently published study conducted by psychiatric researchers at Stanford University, Tufts University, University of Louisville and University of Pennsylvania, SSRIs can increase rapid-cycling and depressive symptoms in individuals with bipolar disorder. The study examined 68 individuals deemed “clinically recovered” from bipolar disorder, all of whom were taking antidepressants and mood stabilizers. The group was randomly divided so that half of the participants continued taking both medications and the other half stopped taking antidepressants but continued with their prescribed mood stabilizers. Most of the individuals who stopped taking antidepressants had few to no depressive episodes throughout the following year, while those who continued taking antidepressants encountered rapid-cycling with an average of 2 to 4 depressive episodes during the same timeframe. As the study concludes, “In this sample, long-term continuation of antidepressants was associated with more mood episodes in patients with rapid-cycling bipolar disorder, particularly with threefold increased rate of depressive episodes in the first year of follow-up.” Studies have not yet been conducted on the effects of SSRIs on the rapid-cycling of minors with bipolar disorder.
NIMH reports that children with anxiety disorders are at greater risk of developing bipolar disorder than the general population. If you or your teenager is struggling with bipolar disorder or any symptoms of anxiety, mania or depression, help is available. Sovereign Health Rancho San Diego is a facility that specializes in treating adolescents and teenagers struggling with mental health issues, substance abuse and dual diagnosis. Call 866-615-7266 to speak with a professional today.
Written by Courtney Howard, Sovereign Health Group writer